The psychiatric advanced directive (PAD) is a form that provides essential information about the patient with behavioral health needs. Written with the patient when they are in stable and well condition, the document allows the person to identify what medications they have been prescribed, and which medications are most helpful in a crisis, which physicians they have seen, who normally cares for them, recent hospitalizations, hospitals of preference, conservator’s name, etc.

The PAD lists the appropriate contact persons for additional decision making. This document is important because a patient with psychiatric needs may be brought into any hospital by the police, family, EMT, and may go from hospital to hospital. This document would allow continuity of care and save time and effort in the emergency department.

When a county adopts the use of the PAD, they are scanned into the electronic medical record. The County of Solano (as part of a State of California initiative) is considering using psychiatric advanced directives in emergency departments. To assist with County planning, a project led by Hazel Aguirre, RN, Staff Nurse IV, is finding out the status quo. Have patients begun to use the PAD? Is it being brought into the Emergency Department for care planning purposes? To date, Hazel has assessed 62 adult patients over 3 months. None have come to the Emergency Department with an Advanced Directive.

In this joint project between NAMI (the National Alliance of Mental Illness) Solano, the Emergency Department, and the screening psychologists from Behavioral Health, Kaiser Permanente Vacaville Medical Center is advancing the evidence-based practice of continuum of care for patients with mental health needs.